Coventry Health Care, Inc.

Review: I had an individual health insurance plan with Coventry. I received a letter that my plan was being terminated due to [redacted]. I used to have my monthly premium debited from my checking (aprox $45.00 per month). I decided to go with a new health insurance plan from a different company for 2015. Coventry debited $186 from my checking Jan 2nd, 2015. When I spoke with them they claim I was auto enrolled into a new health insurance plan from them even though I didn't choose it. When I told them to cancel this policy and refund my money they are stating I have to submit proof that I had a different insurance as of Jan 1, 2015 (which I do and can provide) and also submit a form to cancel my current policy. My problem is I was told my current policy was being canceled and never agreed to a new policy and or signed any such agreement for a new monthly amount to be debited, so why do I no have to submit this proof and forms in writing to cancel this new policy and get my money back?Desired Settlement: Refund of my $186 and Coventry to change there policies to change peoples insurance plans, amount being debited from checking accounts so this doesn't happen to other people.

Business

Response:

Dear

Review: A check I mailed was cashed but never credited towards my account. I contacted them 3 times and the problem is still not resolved.

On 6/26/2014 check number [redacted] for $91.93 was cashed against my bank account, but these funds were never credited to my account by Coventry. I tried contacting them by email but received no response at all. I later called (not sure of the date, but the call reference number is [redacted]) and explained the problem, and was assured by the woman on the phone that she would get it fixed for me. After a few weeks the funds were still not credited, so I called again on 10/6/2014 (reference # [redacted]) and was again assured by the rep that she would get the problem fixed. It's now been 3 weeks since that call and the funds are still not credited.

My policy number with Coventry is [redacted] and my billing ID is [redacted].

Additionally, they always send me my bill a few days before it is due. No matter how quickly I put a check in the mail, they invariably send me a notice that I haven't paid my bill on time.Desired Settlement: I would like a refund of $91.93 that was sent. I do not plan to keep Coventry as my insurance so I would prefer a check instead of an account credit.

Business

Response:

Member monthly billing statements are generated between the 8-13th of every month; premium payments are due by the 30th of the prior month. Unfortunately, a refund will not be issued to the member since the policy is currently active. Our records show [redacted] obtained her coverage through the Marketplace; therefore a request for termination must also be done through the Marketplace. Once the policy has been terminated, then the member will receive a refund for any additional premiums paid after her termination date.

If [redacted] has any further questions she may contact our Executive Resolution team directly at [redacted]@aetna.com.

Thank you.

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because they did not address the issue at all. The problem is that I sent a payment that was never credited to my account. They did not reference the actual complaint, let alone take time to address it. Whoever wrote the reply is an it who should be fired from their job.

Review: Coventry Healthcare does not answer their phones. I have spent countless hours being placed on hold or routed to the wrong department. They are not customer centered at all.Also, I signed up for CHC under The Marketplace. After signing up with CHC, I discovered that a drug I need to take everyday is not covered. The monthly cost for that drug is $358 which is more than my premium. CHC said it is a Tier 2 drug and there is nothing they can do to adjust the cost of this lifesaving drug. UNBELIEVABLE. They are unwilling to budge on making any allowances for this drug. I can no longer afford this drug but when I try to call CHC to get this matter resolved, I get lost in Phone Hold [redacted]. One day I spoke to 5 different people in 3 different departments and was on the phone for over 2 hours. I have documentation of my complaints. At present, I am begging CHC to allow my much-needed drug to be financially accessible. Their lack of concern is chilling.Desired Settlement: I want my drug to be covered under my plan. I also want to alert other consumers about the POOR quality of Coventry services. I would never want anyone else to suffer through what I have endured through Coventry.

Business

Response:

July 17, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Kansas, Inc. (“Coventry Health Care”) writes this letter in response to the above-referenced complaint filed by [redacted] regarding insulin affordability.**. [redacted] chose an individual full-risk PPO Silver Plan effective May 01, 2014. **. [redacted] is currently receiving [redacted] insulin. [redacted] is on the Tier 2 prescription drug list. The pharmacy benefit for Tier 2 Preferred Brand Drugs is the preferred pharmacy deductible + $45.00. **. [redacted]’s annual deductible is $2,500.00. After her deductible is met, benefits will be paid minus the $45.00 copay. If **. [redacted] wishes to consider a different plan, plan changes must be processed by [redacted] and can only be made following timelines and guidelines set by [redacted]. It is not something over which Coventry Health Care has any control. Plan change may impact eligibility and premium, and therefore must be processed by [redacted].The only other option **. [redacted] may have is to do a web search for Manufacturer Coupons. She may need to consult with her pharmacy to determine if there are any discount programs.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####. My fax number is ###-###-####, and my e-mail address is [redacted].Very truly yours,

Review: For the last month to a month and a half I have not been able to touch base with my health insurance provider. I've requested my login information from the website four times now with no response. I receive emails from Coventry Healthcare about changes to my plan on a regular basis so I know they have the right email address for me, but never are able to help me log in to my account. I've also called several times only to be left on hold a minimum of thirty minutes each time. My coverage is about to skyrocket from roughly $70.00 a month to $188 a month. The only paperwork in the mail I've received limits me to only one policy to change to, so I've been given no additional options. As much as this coverage costs me, it is disturbing that I am unable to reach my provider. Any questions I may have or assistant I need is not being heard. What's more disturbing is the possibility of numerous other experience the same problems. I am paying for a service and expect much better communication than this.Desired Settlement: I wish to cancel my policy all together. I'd rather start over and find a company that has time to speak to me.

Business

Response:

February 4, 2014

Dear **. [redacted]:

This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to a complaint submitted by [redacted] regarding a change in policy and premium increase for his CoventryOne policy effective since February 1, 2012. The request was received by CHC Carolinas on February 3, 2014.

CHC Carolinas does not have a signed authorization release form from **. [redacted] indicating that the Revdex.com is representing him in this matter. CHC Carolinas will respond directly to **. [redacted].

Please contact me if you have any further questions involving this issue. I can be reached at ###-###-####-[redacted] between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday.

Sincerely,

Review: This company sent me a bill saying my payment was due on June 9, 2014 I sent them a check on the 27th of May for $282 they cashed the check on June 3, terminated my services on June 10 or 11th and they're refusing to reinstate my policy and I've called this company at least five times over the past two weeks get this resolved every time I called there's no supervisor available, as always I am told 24 to 48 hours and nothing is being done. My bank has even sent proof that they cashed checked. The supervisor that's never available , never call me back. Now I'm being prevented from getting my health services I paid for.Desired Settlement: Health care reinstated or a full refund.

Business

Response:

July 3, 2014Dear [redacted]:I am writing in response to complaint ID [redacted], filed by our member, [redacted].We have thoroughly reviewed the complaint submitted by [redacted] as well as your request for information regarding her complaint.[redacted] has filed this complaint as result of the policy termination subsequent to premium payment.Our records reflect that the appropriate identifying information was missing on the check submitted as payment. As a result, the member’s payment was held in an escrow account until the correct policy was located. As a courtesy we have reinstated the member’s policy. However, premium payment is currently due for the months of May through July. The member may call our customer service department prioir to July 15, 2014 to make payment to avoid termination. The phone number for our customer service unit is [redacted].Of note, please be advised that all future premium payments should include the member’s case number on payments made by check to avoid payments going to escrow.We trust the above information is fully responsive to your request. Should you have any questions or concerns regarding this matter, please do not hesitate to contact me.Sincerely,Candice GAppeal/Regulatory Complaint Coordinator Coventry Health Care

Consumer

Response:

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]

Review: [redacted]

I am rejecting this response because:

This company has not reinstated my policy and if they did , I would only owe July. At this point I am requesting my payment of $282.00 be refunded. I'm no longer interested in being serviced by Coventry .

Regards,

Business

Response:

September 8, 2014Dear [redacted]:I am writing in follow up to complaint ID [redacted], filed by our member, [redacted].Our records reflect that based on the member’s statement that the first refund had not been received, the member was re-issued a refund on August 29, 2014 in the amount of $282.00 to the mailing address provided by the member of [redacted].We trust the above information is fully responsive to your request. Should you have any questions or concerns regarding this matter, please do not hesitate to contact me.Sincerely,Candice GAppeal/Regulatory Complaint Coordinator Coventry Health Care

Consumer

Response:

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

Regards,

Review: At the beginning of May my job decided that it's employees would have to use the healthcare marketplace for health insurance. I was signed up and the effective date was to be June 1, 2014. The information was not entered in it's entirety causing me to not receive any information from Coventryone. When I contacted Coventryone on June 2, 2014 I was informed the policy had terminated and I would have to sign up again. On June 13, 2014 I called the marketplace again and completed a new application requesting a July 1, 2014 start date. On June 29, 2014 I called to pay the initial payment but was told by Coventryone that they did not have any policy information and to contact the healthcare marketplace, which I did. On July 03,2014 an escalation was entered in order to have coventryone send out information. I did not receive any information referencing a policy until July 27, 2014. I made the initial payment on July 31, 2014. Upon calling the member services number I was still not given a member id number or cards and was informed that one had not been issued yet. I did not receive any of that information until the second week of August. I asked for my effective date to be changed to August 1, 2014 because I was unable to use the insurance and they stated that I could not utilize the insurance at all until the past due balance was paid which would be a premium from June 1,2014. A secondary escalation was put in which I was informed could take 30 more days to be resolved. Even with all this information Coventryone is still demanding that I pay for the months of June and July even though I had no coverage and did not attempt to submit any claims during this time. They have refused to change the effective date. It should also be noted that the healthcare marketplace has my effective date noted in there system as July 1,2014. So Coventryone has pulled a June 1, 2014 start date out of the air. They are demanding payment or they will terminate my coverage on 9/30/2014 and not offer any refund.

Account_Number: 80379451601Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like to have my effective date changed to August 1, 2014 as so that I am not wasting 455.44 (cost for two months of insurance) when I was unable to use it for reasons that were out of my control. Upon this change the premium for the month of September can be paid.

Business

Response:

September 26, 2014Dear [redacted]:Your letter of September 19, 2014 to Coventry Health Care of Virginia, Inc. (“Coventry Health Care”) was referred to my attention for review and response. [redacted] is covered under Coventry effective July 1, 2014.On May 8, 2014, Coventry initially received information from the Health Insurance Exchange (“Marketplace”) advising [redacted] would have coverage effective June 1, 2014 once she made her initial binder payment. Coventry received a corrected file feed from the Marketplace updating the effective date to July 1, 2014.On July 31, 2014, [redacted] paid the initial binder payment and her policy was issued with a July 1, 2014 effective date based on the enrollment information received from the Marketplace. Policies purchased on the Marketplace require full payment of the initial binder payment in order to enroll the member. Therefore, [redacted] would not have received any member materials until she paid the initial binder payment.On September 26, 2014, Coventry reached out to [redacted] to discuss her concerns in detail and explained we were unable to change her effective date to the now requested August 1, 2014 based on Exchange rules and regulations. The Marketplace has advised her effect date is July 1, 2014 and not August 1, 2014. [redacted] was provided with the premium amount required to bring her account current.Coventry is unable to process any changes to a policy that was initiated through the Marketplace per the Exchange rules and regulations that we as an insurance company must follow.Coventry apologizes for any inconvenience this has caused [redacted]. However, as stated above the change must come through the Marketplace as Coventry is unable to change the effective date based on the Exchange rules and regulations.If you have any questions, please contact the Customer Service Department at ###-###-####.Sincerely,Teresa EManager, Complaint and Appeal Program

Review: I filled out a form to cancel my policy since I got better insaurance. However, they are still deducting money from my bank without my permission.Desired Settlement: DesiredSettlementID: Refund

I need the money back that was deducted after I canceled.

Business

Response:

July 28, 2014Dear Sir or Madam:The Regulatory Compliance Department of Coventry Health Care of Missouri, Inc. (“Coventry Health Care”) writes this letter in response to the consumer complaint filed by Crystal Rose regarding continuation of insurance. The member states that she filled out a form to request cancellation of her policy however, a subsequent payment deduction still occurred.Research into this matter revealed that this member has an On-Exchange policy that was purchased through the Marketplace. As a carrier, Coventry Health Care is not able to terminate coverage on this policy. The member must reach out to the Marketplace and initiate the termination record through them. The exact procedure would be for the member to log into the marketplace website that was used to enroll. According to the Healthcare.gov website there will be a red button titled “Terminate/end all coverage”. Once that is completed a file will be sent electronically from the Marketplace to the issuer (Coventry) to terminate the policy.Though it might seem to Coventry’s customers that it should be able to make changes to their coverage such as terminating coverage based on a member request without requiring direction from the Marketplace itself, Coventry is unable to make that change. The structure of the ACA forces changes like this to occur only at the federal marketplace, and not at the health carrier, level. The federal marketplace is working on their systems at this time, and they are erroneously sending customers to their carriers to make these changes. The customer must work through the federal marketplace in order to make this change on their end.The Exchange is the source of truth for enrollment and SEP determinations. Consumers must enroll through the Exchange, the Exchange sends an 834 (standard EDI transmission) to Issuers that triggers enrollment actions and Issuers send back to the Exchange a confirmation. Issuers are also notified by the Exchange of approved SEPs.Issuers may not make enrollment changes, including SEPS, outside the Exchange process.Therefore, in order for the member to cancel her policy, she must take the steps described above to do so. Once Coventry Health Care receives the Marketplaces’ data, it will terminate the member’s policy as she has requested.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-####, extension [redacted]. My fax number is ###-###-####, and my e-mail address is [email protected] truly yours,Neil M[redacted], B.A. Regulatory Compliance Analyst Coventry Health Care

Review: purchased health policy and following receiving policy used pharmacy for medications and was penalized an extra $ 45.00 for a medication that is medically necessary and under federal law to get at local pharmacy since it is a pain medication under federal law required to get at a local pharmacy and I was penalized $ 45.00 due to not using this companies mail order pharmacy which was never told to me at time of sale of policy or there after.I further demand refund of this money I had and was forced to pay at local pharmacy when copay for medication is $ 15.00 I also demand a written apology from this company and further disclosure of any other hidden clauses and fees of this policy from this company.if this money is not further refunded I will take further action with a congressman since this is a federal policy purchased thru the federal health market.Desired Settlement: refund of cash paid and further disclosure of any other hidden agenda fees by this company due to their misrepresentative of this policy.also demand to be able to get my medications this is medically necessary and under federal law must be purchased and received at a local pharmacy.apology letter for ripping me off by the company charging me more money then copay was supposed to be which is $ 15.00

Business

Response:

June 3, 2014Dear [redacted]:Coventry Health and Life Insurance Company (Coventry) received the above referenced complaint in our office on June 4, 2014. We appreciate the opportunity to respond.Coventry does not have a signed authorization release form from the member indicating that the Revdex.com is representing [redacted] in this matter. Therefore, Coventry is responding directly to [redacted].We trust this adequately responds to your inquiry.Sincerely,

Review: I had this insurance through my husband. I was going to have [redacted] injection by this Dr.( [redacted]) to my Left knee and they cost over 800.00. Well before I had the shots the doctors office talked with the [redacted] Insurance to see if my deductable had been met the Insurance said yes my deductable had been met.It would pay for the shots. This was approved on paper sent to the physicians office. When I went back to the doctor a couple months later the doctor office told me I would have to appeal the Insurance which I did but have not gotten any money back. To my surprise that same day I had to pay around 250.00 to the Dr. because the Insurance did not pay. ( I have a message into the bank for exact amount). I now have to pay them (the doctors office) 525.96 or it will go to collections. My deductable was met I knew it was , I have called the company several times and get no response they owe me almost 800.00. I had to go to my savings to pay.Desired Settlement: DesiredSettlementID: Refund

I want my money refunded to me , all of it.

Business

Response:

December 9, 2014Dear [redacted],Your letter of September 21, 2014 to Coventry Health and Life Insurance Company (“Coventry”) was received in our office, and referred to my attention for review and response, [redacted] was on a Preferred Provider Organization (PPO) policy with a July 1, 2011 effective date, [redacted], [redacted] enrolled for coverage through her spouse’s employer. The [redacted]’s policy terminated on June 30, 2014.In her complaint to the Revdex.com, [redacted] expressed she was misinformed about her deductible by Coventry. **. [redacted] also requests a refund of the money she paid out of pocket to her provider because her individual deductible had been met.The [redacted]s were under an Umbrella Family Policy with a $5,000.00 family deductible. Their Certificate of Insurance states the following:ARTICLE I – DEFINITIONSAny capitalized term listed in this Article I shall have the meaning set forth below whenever the capitalized term is used in this Certificate of Insurance.1.28 Deductible: Shall mean the amount You owe for health care services before We begin to pay, For example, if Your deductible is $1,000, Your Plan will not pay anything until you have met your $1,000 deductible for Covered Services subject to the deductible. The deductible may not apply to all services.If You do not have any Dependents enrolled under the Contract, You must meet the individual Deductible shown in Your Schedule of Benefits before health care services subject to the Deductible are Covered under the Contract. If You have one or more Dependents enrolled under the Contract, You can cither have an Umbrella Deductible or Embedded Deductible:• The Umbrella Deductible is met by any combination of Members meeting the total family deductible. After the contract year family deductible is satisfied, the Health Plan will pay for Covered Services, minus any applicable Copayments or Coinsurance, for each Member.• The Embedded Deductible is met by an individual family member if that family member meets the Individual Deductible. Once the individual family member satisfies the Individual Deductible, the Health Plan will pay for Covered Services, minus any applicable Copayments or Coinsurance for that family member. If the Family Deductible is Inet by any combination of family members, the Health Plan will pay for Covered Services, minus any applicable Copayments or Coinsurance for all family members, Please refer to the Schedule of Benefits for details on your Individual of Family Deductible.[redacted] filed an appeal on June 24, 2014 to request that her family deductible be waived on services provided by Dr. [redacted]. On July 23, 2014, the Grievance Committee Panel reviewed [redacted]’s appeal request and determined that the claims submitted by Dr. [redacted] were processed appropriately with the correct member liability applied to each claim. Therefore, [redacted] is not owed a refund for the out of pocket expenses she incurred according to her Certificate of Insurance (CCI) and Schedule of Benefits (SOB).If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted].Sincerely,Shawn M.Complaint and Appeal Analyst

Consumer

Response:

Review: [redacted]

I am rejecting this response because:

-------- Forwarded message ----------

From: <[redacted]>

Date: Fri, Nov 14, 2014 at 9:00 AM

Subject: Re: You have a new message from the Revdex.com of Metro Washington DC & Eastern Penn...

To: [email protected]

I sent a signed letter to the insurance company to give permission to get my medical records a few days after receiving this letter. Thank you and have a great day !

Review: I have congested heart failure, gout and arthritis. Coventry cut off my prescriptions so now I can't get the meds I need. I don't have money, I'm poor

Medicare changed my insurance to Coventry Health Care Part D. Ever since then my life has changed drastically. I have congested heart failure, gout and arthritis among other things and I haven't had my medical prescriptions in months. My gout has had several outbreaks in the last months. My health has taken a downward slope and I need my medication. I can't do thing like I used to and I am so sad about it. I am disabled because I am sick and that means that my income is limited. I can barely afford utilities and rent, how can I afford these expensive medications. My wife and children look at me and cry. My family prays for my health daily because it is only by the grace of God that my health hasn't worsened. I don't get my medications every 30, 60 or 90 days because I can't afford. Coventry hasn't assisted me in finding a way to afford. They haven't contacted me for help in any way. I just need my medicine. I need my [redacted] medication.Desired Settlement: I want them to give me my medications and help me to continuously afford it. It's so sad how they do poor people. We can't even get any help.

Business

Response:

October 17, 2014Dear [redacted]:This letter is in response to your written inquiry dated September 24, 2014. In that correspondence you asked about the following:You expressed concern about the cost of your medications using your First Health Part D Essentials (PDP) Plan.Based upon a review of your benefit plan, you contacted the Revdex.com regarding your concern over the cost of medications using your First Health Part D Essentials (PDP) Plan. You shared that you have experienced difficulty affording your medications and would like assistance from your plan. We are deeply sorry to learn of your experience and frustration. We would like to provide an overview of the 2014 First Health Part D Essentials (PDP) Plan.As a reminder, the 2014 First Health Part D Essentials plan is a 3 tier plan. After you meet your deductible of $310, you will enter the Initial Coverage stage. During your Initial Coverage stage what you pay for medication will depend on what tier the medication is on and where you fill your medication. The tier of each medication can be found in your formulary. Additionally, by using our preferred pharmacies, you can lower your cost share for covered prescriptions. Our preferred pharmacies in your area include: [redacted] Pharmacy, [redacted] Pharmacy, and [redacted] Pharmacy. In addition to these major retailers, your preferred pharmacy network also includes some local pharmacies. You may refer to your pharmacy directory for local pharmacies in your area that are included in our preferred pharmacy network. For questions about a particular drug or pharmacy, please contact the number listed at the end of this letter. You remain in this stage until the total cost of your covered drugs (the amount you pay combined with the amount we pay) reaches $2,850.After your total yearly drug costs reach $2,850, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 72% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,550.After your yearly out-of-pocket drug costs reach $4,550, you would enter the last stage of coverage known as the Catastrophic stage. During this stage, the plan will pay most of the cost for your covered drugs for the remainder of the calendar year. Your share of the cost for a covered drug will either be a coinsurance (percentage of the cost) or a copayment, whichever is the larger amount. You will pay either a coinsurance of 5% of the cost of the drug or either a copayment of $2.55 for a generic drug (or drug that is treated like a generic) or a copayment of $6.35 for all other drugs.In your inquiry, you expressed a concern about your prescription copays. To address this concern, we would like to share the following information with you regarding the plan design and cost share associated with your 2014 First Health Part D Essentials (PDP) Plan. After the $310 deductible has been met, the cost share associated for a drug filled at an in-network preferred pharmacy during the initial coverage stage is as follows: 30 day supply 90 day supplyTier 1 drug $1 ????? $3 ????? Tier 2 drug 15% coinsurance 15% coinsurance Tier 3 drug 44% coinsurance 44% coinsuranceThe design of our plan for 2014 takes many factors into consideration including feedback received directly from our members. Copays are an effective way to help members budget for their expected drug costs. This change was made in an effort to improve our plan design for members and lower their overall out of pocket costs. If the cost of your medication is less than the co-pay assigned to your drug, you will pay the negotiated rate for the drug. We appreciate your feedback as it will help us design plans that meet our members’ needs in the future.You commented that your plan is not providing coverage for any of your medications. Our records indicate that your enrollment in the First Health Part D Essentials (PDP) Plan ended on April 30, 2014. This termination of coverage was due to non-payment of your plan's monthly premium. The premium associated with your First Health Part D Essentials (PDP) Plan is $47.10 per month. If you do not pay the plan premiums for two (2) or more calendar months from the date on which the monthly plan premium was due, we must end your membership in the plan. This does not apply to full dual members and members receiving “Extra Help”. We must notify you in writing that you have two (2) calendar months to pay the plan premium before we end your membership. Low Income Subsidy (LIS) and dual eligible members will not be dis-enrolled for failure to pay premium.[redacted], you shared that you are disabled and have a low monthly income. People with limited incomes may qualify for extra help to pay for their prescription drug costs. If you qualify, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify won’t have a coverage gap or a late enrollment penalty. Many people qualify for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at ###-###-####. TTY users should call I-800-325-0.778, You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp.You also shared that you do not have Prescription Drug Coverage. We encourage members to make well-informed healthcare decisions. If you would like to explore other plan options for 2015, we encourage you to contact a SHIP counselor at ###-###-####, Monday through Friday 8:00am - 5:00pm. You may make changes to your Medicare coverage during the Annual Enrollment Period (AEP) starting October 15 through December 7 to be effective January 1.[redacted], you expressed in your inquiry to the Revdex.com that your desired outcome is for First Health Part D Essentials (PDP) to provide you with coverage for your medications. We would like to offer our sincerest apologies to you, but unfortunately as indicated above, you are no longer a member of the First Health Part D Essentials (PDP) Plan as of April 30, 2014. Because you are no longer a member of a First Health Part D plan, we are unable to provide coverage for your medications. We encourage you to contact Social Security and/or a SHIP counselor to learn about any financial assistance programs that you may qualify for.We appreciate you contacting us, and trust the additional information that we have provided satisfactorily addresses your inquiry. Your inquiry provides us with valuable insight as we continuously seek opportunities to improve our member communication materials. Thank you for allowing us to serve your prescription drug needs.Should you have any further questions, please contact Customer Service at ###-###-####, 24 hours a day, seven days a week your local time. TTY/TDD users please call 71 | Telecommunications Relay Services.Sincerely,Kristy HMedicare Appeal & Grievance Coordinator

Review: In August, my family and I moved back from oversees and needed health insurance for a one month period until I began law school and received health insurance from the university. Through our insurance agent, [redacted] (The [redacted], [redacted], ** ###-###-#### Ext. [redacted]), we purchased a one month health insurance policy from Coventry (policy number [redacted]). We paid for that one month by [redacted] credit card, but as “a formality,” Coventry asked me for my bank account information, assuring me that it was only for the purposes of setting up the policy.

About one month later, when my Coventry plan was to end, I signed up for health insurance through [redacted] StudentResources through [redacted] State University (policy number [redacted]). Despite our request to end our coverage, a few months later, upon reviewing my bank statements, I noticed that Coventry was taking $380.75 out of my bank account each month, which they were never authorized to do. I immediately contacted my insurance agent who contacted [redacted], an account executive with CoventryOne of [redacted] (###-###-####) who claimed that Coventry would stop taking the money and reimburse me for what they had already taken over the course of months.

Needless to say, this never happened. They continued to take money out of my account and refused to cancel my policy. On February 11, 2013, I gave my bank a stop payment notice for the payments, and it was only then (after not being paid), that Coventry woke up and cancelled my plan. My insurance agent and I have been desperately trying to get themto reimburse me for the exorbitant $2284.50 that has been taking from me, but to no avail.

Numerous times, we or our insurance agent have contacted Coventry to resolve the problem, but each time they reassure us but then nothing happens.

On July 10, 2013, I sent a letter to local Coventry customer service office detailing my problem and enclosing all the correspondence and detailed paperwork showing that we have repeatedly asked for reimbursement and indeed cancelled the policy after that first month. No one even had the courtesy to acknowledge that the package was received.

I am growing increasingly frustrated, and this complaint is my last step before going to court.Desired Settlement: I want the $2284.50 that was taken from me without permission and without authorization to be refunded to me immediately.

Business

Response:

Attached please find Coventry Health Care, Inc.'s response to Complaint #[redacted].

Thank you,

Review: I recently had an appointment at the [redacted] Family Clinic with Dr. [redacted]. Before the appointment I called to see if the clinic was compatible with Coventry of Iowa. One of the billing associates, Ashley B[redacted], stated that I would receive the same copay/member responsibility as other hospitals that are within the Coventry network. However, I received two bills from Coventry and Coventry is stating that they will only cover a minimal portion of my visit/bill and I have to pay approximately ~$300 total. This is not congruent with the portion charged at other clinics. [redacted] Family Clinic stated that that could resubmit the bill for the visit under "no insurance." I could then receive a more significant discount from the total bill under [redacted] rates for a person not filing under an insurance policy.

My insurance policy is with Coventry of Iowa.Desired Settlement: [redacted] Family Clinic is going to refile the claim with no insurance. Please cancel this claim and monies and will pay [redacted] Family Clinic directly.

Business

Response:

September 12, 2014Dear [redacted]:Your letter of September 9, 2014 to Coventry Health Care of Iowa, Inc. (Coventry) was received in our office, and referred to my attention for review and response. [redacted] is on Qualified High Deductible Health Plan Open Access Health Maintenance (QHDHP OA HMO) policy with a February 1, 2014 effective date through his spouse’s employer.In his complaint to the Revdex.com, [redacted] advised that one of the billing associates with Hansen Family Clinic stated he would receive the same copay/member responsibility as other hospitals that are within the Coventry network. [redacted] is on a QHDHP policy and his annual family deductible is $5,000.00. [redacted] does not have a copayment associated with his policy. Therefore all services would be subject to his $5,000.00 annual family deductible.Coventry processed several claim submissions for [redacted]. The claims processed at the negotiated contract allowance with the providers. [redacted] would be responsible for the amount subject to his deductible. There was no payment issued to the providers of service.If the providers notify Coventry that the claims should not have been submitted, the deductible amounts will be removed from [redacted]’s policy. At this time, Coventry has not received any corrected claims from the provider of service.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted].Sincerely,Teresa EManager, Complaint and Appeal Program

Review: Got final demand for payment in the mail on 1/6/14 to pay within 10 days of the date on the letter 12/25/13.

I received a final demand for payment to be paid within 10 days of date on the letter. The letter was dated 12/25/2013, I didn't receive the letter until 1/6/2014. I used bill pay to pay them and according to the bank the payment was delivered on 1/10/2014 but has not been debited from my account. I have tried to call them to settle the debt but I haven't been able to talk to anyone, I have just been sitting on hold with no luck. I'm trying to pay them, but they are making it impossible.Desired Settlement: Accept the payment I sent

Business

Response:

February 18, 2014

Dear Sir or Madam:

The Regulatory Compliance Department of Coventry Health Care of Nevada (“Coventry”) writes this letter in response to the consumer complaint filed by Valerie Smith regarding billing, payment and collection issues on her policy.

[redacted]’s policy had been terminated for non-payment of premium and a remaining balance of $40 was outstanding. Coventry had difficult making contact with [redacted] and was finally able to do so last Friday. She indicated that email was the best way to communicate with her. Although at the time of contact Coventry informed [redacted] that we would email her a copy of the final demand letter and instructions of where to send the $40 payment for the return fees, and in fact did so, after further consideration it was determined that Coventry would waive the $40 fee. A follow up email was seat to [redacted] today to so inform her.

Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-#### and my e-mail address is [redacted].

Sincerely,

Review: I have been with coventry health care for about 2 years. I have never had a problem with service until recently. I went to the dentist recently and when I returned home I received a call that my dental has been denied and that my policy has been terminate. I received no notice of termination of policy. So when I got informed by the dentist that I was terminated that was my first time receiving that information. I have tried countless times to contact this company. Every time I call I get to customer service they tell it is a manger issue and that the manager will get back with me. It has almost been 3 weeks and no manager has contacted me. I have called about 7 times and I get the same response from other service representatives.Desired Settlement: I would like coventry to cover my dental appointment considering that I never received a notice of cancellation of policy. per my understanding my policy was cancelled november 31 and my dental service was on december 2.

Business

Response:

January 14, 2014

Dear **. [redacted]:

Thank you for giving Coventry Health Care of Georgia (Coventry) the opportunity to review your Revdex.com complaint. We appreciate your feedback in regards to our Customer Service process.

Our records indicate your CoventryOne individual policy became effective 10/15/11 including dental coverage. Your complaint alleges you did not receive adequate notification of the cancellation of your dental coverage effective 12/1/13. Please see the attached renewal notification letter dated 8/30/13 notifying you that dental coverage will not be included with the 12/1/13 renewal of your medical policy (Attachment). You did not have dental coverage on 12/2/13, therefore charges for the cleaning denied appropriately.

If you have any questions, please contact the Customer Service Department at ###-###-####.

Sincerely,

Review: I wrote Coventry One on April 30th 2014 to inform them of me becoming eligible for my company insurance on May 11th 2014 and they continue to bill me.I sign up for insurance as government request. I chose Coventry One through the Health Care Market Place in March of 2014 and informed them of my company option after 90 days. I got insurance through Blue Cross on May 11th . I wrote Coventry One on April 30th informing them of my need to cancel. They never wrote back and continued to send me a bill. I tried to call and you can not get through to a real person. I tried every option on the phone. I write again in July and September . They refuse to answer and I believe that this is a way to try and extort money from people. There are thousands of customers who are ripped of and have ruined credit because of companies like Coventry One. There is no way to contact a real person so they can easily dispute that you tried to contact them. The phone answering system is designed to steer you to the internet instead of getting an actual person. It's a travesty that companies are allowed to operate like this and continue to profit by causing so much misfortune. Policy number [redacted] /Health / Silver $10 Co Pay PPO Carelink . They continued to send me a bill after I mailed in my last paymeny of $106.00.Desired Settlement: DesiredSettlementID: Other (requires explanation)

I would like the Revdex.com to try and call the number given ###-###-#### and try an reach an associate. I would like Coventry One to stop sending me statements claiming I owe them money. I owe this company nothing. I do not owe anything . I want them to send me a letter responding to the April 30th letter July letter , and Sept letter I wrote. I would like Coventry One to stop using extortion tactics to try and make a profit. I wo

Business

Response:

November 10, 2014Thank you for your inquiry received on November 04, 2014, regarding complaint #[redacted] for [redacted] and his request for termination of his policy. Our Executive Resolution Team researched your concerns and I would like to share the results of the review with you.We reached out to our Enrollment department for assistance during our investigation. No letter was found requesting termination of the policy. Regardless, the member obtained his policy through the Marketplace so all termination requests must be made with the Marketplace. The member made three payments that covered May, June, and July 2014. The policy has now been terminated effective August 31, 2014, due to nonpayment of the premium. The member was allowed a 90 day grace period and when a payment was not received by the end of the grace period our Enrollment department processed the termination on October 31, 2014. Even though no payment was made for the month of August, the policy remained active for the first month of the grace period in accordance with the policy setup for the Marketplace members with subsidized premiums.The member did request to terminate through the Marketplace in November and a termination file was sent on November 03, 2014. This file had an effective date of termination of November 30, 2014. However, this file did not process as the policy was already being terminated for nonpayment.The phone number ###-###-#### is a valid number for reaching Coventry Enrollment representatives. We apologize that the member was not able to reach someone. We have shared the member's experience with the management team in our Customer Service department for improvement opportunities.We take customer complaints very seriously and appreciate you taking the time to contact us and giving us the opportunity to address [redacted]’s concerns. If you have any additional questions regarding this particular matter, please contact the Executive Resolution Team at [redacted]@aetna.com.Sincerely,Christopher B Complaint and Appeals Consultant Executive Resolution Team

Review: I received a letter stating that my policy had been cancelled as per my request. I never requested that.

On September 30, 2014 I received a letter stating that my coverage had been cancelled as per my request. I called the company and asked why my policy had been cancelled when I had not requested that it be. I was told that I had not responded to a request for proof of citizenship. I informed the representative that I had never received any such request. I was told that several other customers had said the same thing. When I asked what I needed to do to get my coverage back and was told that there was no solution to the issue. I have no coverage and the company will not do anything to correct the problem.Desired Settlement: I would like to have my coverage reinstated or my premiums back

Business

Response:

October 22, 2014Dear [redacted]:Your letter of October 16, 2014 to Coventry Health Care of Iowa, Inc. (Coventry) was received in our office, and referred to my attention for review and response. [redacted] was on a CoventryOne Individual policy with a February 1, 2014 effective date. The policy terminated on September 30, 2014.In his complaint to the Revdex.com, [redacted] advised his policy was terminated without notification due to a lack of proof of citizenship. [redacted] would like his policy reinstated.The [redacted] issued a letter to [redacted] that advised proof of citizenship needed to be submitted to them in order for [redacted] to continue his health insurance coverage. Since the [redacted] did not receive proof of citizenship from [redacted], the [redacted] sent a policy termination file to Coventry on September 16, 2014. The file instructed Coventry to terminate [redacted]’s policy effective September 30, 2014.The request for proof of citizen is solely handled by the [redacted]. Coventry does not have a copy of the notification letter sent to [redacted]. Coventry is unable to reinstate a policy that was initiated through the [redacted] per the Exchange rules and regulations that we, as an insurance company, must follow. [redacted] needs to contact the [redacted] directly to inquire about his policy termination. The [redacted] phone number is ###-###-####.If I may be of any further assistance, please feel free to contact me at ###-###-#### or toll-free at ###-###-####, ext. [redacted].Sincerely,Shawn M. Complaint and Appeal Analyst

Review: I've been trying since early August to cancel my policy and they won't let me.

I've been trying to cancel my policy since early August. I have sent at least a dozen phone calls and emails trying to make that happen. I have been given the runaround, referred to different departments, given different and conflicting errors, been sent on needless paperwork chases, and they even took September (and possibly October) premiums without my permission. Then when I disputed the charge with my bank they charged me a service fee for insufficient funds, for the premium I refused to pay. They also made me overdraft on my account causing significant financial hardship.Desired Settlement: I simply want my policy cancelled, effective August 31st, a written letter notifying me of this cancellation, and a written promise that they will not withdraw money from my account. I also want the insufficient funds fee removed from my account.

Business

Response:

October 10, 2014Dear Sir or Madam:Thank you for allowing us the opportunity to respond in regard to the case filed by [redacted].We have been communicating with [redacted] regarding the process for policy termination. According to our records, [redacted] contacted us on 08/06/2014 to change his plan. We then received a telephone call from [redacted] on 09/08/2014 requesting that we cancel his policy effective 08/31/2014. At that time we advised [redacted] of the termination process and the required document for him to submit in order to initiate the policy termination. On 09/22/2014 [redacted] called inquiring about the termination of his policy. Our representative explained that we had not received the required document to terminate his policy. Because we not yet received the documentation required to terminate [redacted]’s plan, the policy remained active and we attempted to draft his account for September’s premium.We have since received the required documentation to terminate [redacted]’s policy and his policy was terminated effective 08/31/2014. The September premium was never received as our draft was returned to us from [redacted]’s bank for insufficient funds. We originally charged a $20 fee for the returned draft, however, we have since waived this fee on [redacted]’s account.[redacted]’s complaint has been resolved according to the desired resolution that he requested.Coventry Health Care hopes this explanation provides the Revdex.com with the necessary information to complete the investigation of this matter. If you have any further questions or concerns, please feel free to contact me at ###-###-#### and my e-mail address is [redacted].Very truly yours,Shelly UDirector, Service Operations

Review: Coventry One received my payment on 5/30/14, cashed checked and won't credit my account. My bank has provided front & back copies of check to them.

Coventry One (PO Box [redacted], Fl [redacted])(phone number ###-###-####) received my payment for health insurance on 5/30/2014 through bill pay from [redacted]. They cashed my checked (check #[redacted] ) and won't credit my account. My policy ID is [redacted]01 & Billing ID/Case number is [redacted]. My bank ([redacted]) has provided front & back copies of the check to Coventry One showing that it was cashed by them but they still haven't credited my account/rectified the situation. My health insurance policy is at risk of being terminated even though I continue to make payments. My account keeps showing delinquent which puts me at risk of no health insurance. I have called 8 times since 6/26/2014 and no one has rectified the situation. I called on 6/26/14 and spoke with Trensa, 6/30/14 spoke with Veronica, 7/8/14 spoke with Devina, 7/14/14 spoke with Tanice, 7/16/14 spoke with Jamie,

7/22/14 spoke with Telisha, 7/28/14 spoke with Dave, and 8/12/14 spoke with Roberto & Lisa. (confirmation # for my last call is [redacted]) Everytime I call they keep telling me that it will take 3-5 or 5-7 business days and they are escalating the issue. They have my call back numbers and no one has called me back. They have my $267.84 and this issue has been going on since May and it is August.Desired Settlement: I want them to credit my account and compensate me monetarily for stress, pain, and time wasted. I am a mental health provided and dealing with from clients and conflict with my significant other.

Business

Response:

September 19, 2014To whom it may concern:This letter is in response to your request for Coventry Health Care of the Carolinas, Inc. (“CHC Carolinas”) to respond to [redacted] regarding his premium payments not being applied to his CoventryOne® policy purchased on the Federally Funded Marketplace for an effective date of May 1, 2014. The request was received by CHC Carolinas on August 14, 2014.CHC Carolinas responded in writing directly to [redacted] in a letter dated today.I trust that I have addressed this matter sufficiently. However, please contact me if you have any further questions involving this issue. I can be reached at ###-###-####, extension [redacted], Monday through Friday from 8:00 a.m. until 5:00 p.m.Sincerely,Melody C Complaint and Appeal Analyst

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.

------ Forwarded message ----------

From: [redacted] <[redacted]>

Date: Tue, Sep 30, 2014 at 3:15 PM

Subject: Case #[redacted]

To: [redacted]

Hello [redacted],

Review: I had a health insurance policy with them bought through the Marketplace when I was in FL. I moved to TX in June 2014 and updated my address with the Marketplace and I was no longer eligible to continue with that policy and so went ahead and terminated that policy. But, the premium for that month was already paid and so requested for a refund by directly calling Coventry One as Marketplace doesn't handle refunds. So far, I have made 6 or 7 calls trying to get the prorated amount refunded to me with no luck. Today (almost 4 1/2 months after my policy canceled, I was told that the refund can only be sent to my old FL address where I don't live anymore. I logged into my Marketplace account and see my new TX address. In fact, I also received correspondence in the mail directly from Marketplace to my new address, but Coventry One is not updating my address in their system. I demanded the representative that I talk to a supervisor and I was kept on hold for over 30 minutes and simply hung up on me.

Product_Or_Service: Health Insurnace Policy

Account_Number: [redacted]Desired Settlement: DesiredSettlementID: Refund

Please update your records with my new address as sent to you by Marketplace and send me my refund.

Business

Response:

November 3, 2014Dear Sirs:This letter is in response to the aforementioned Case Number [redacted] regarding [redacted]’s request for a premium refund. Thank you for your patience throughout this process. Our goal is to resolve your concern in a fair and timely manner.Please be advised that after review of your grievance, we confirmed [redacted] moved from FL to TX and terminated her coverage due to being outside of network. [redacted] was due a refund but it was mailed to her FL address and [redacted] has been trying to have the refund reissued to her current address.Currently, [redacted]’s policy is reflecting as terminated effective June 17, 2014 per the file received from the Healthcare Marketplace. A pro-rated refund in the amount of $53.83 was issued to [redacted] on August 11, 2014; however, the refund was mailed to the Florida address listed on file. Coventry cannot change a member’s address without a file from the Healthcare Marketplace requesting that change. An expedited request has been submitted to the Premium Accounting team to have a refund re-issued to [redacted]’s to her Texas address. Please allow up to 30 days for processing and mailing.If you have any questions, please contact Customer Service at ###-###-####, Monday through Friday from 8:30 am until 5:30 pm or you may reach me directly at ###-###-####. If you are hearing impaired please call 7-1-1 Telecommunications Relay Service.Sincerely,Yanique MComplaint and Appeal Analyst Grievance & Appeals Dept.